In assessing the Millennium Development Goals (MDGs) on their 10th anniversary, some skeptical and even hostile questions must be asked and answered. More analysis of the targets' ranking is needed to enable meaningful choices to be made among them when not all MDGs can be achieved, and the use of uniform targets for all countries is inappropriate. Additionally, the inclusion of policy instruments as targets has attracted criticism. New leadership is needed to manage the MDGs, addressing the instruments candidly and adding key nuances.